MEDICARE: DURABLE LIFE SKILLS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251C00000X	Developmentally Disabled Services Day Training Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194180695
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DURABLE LIFE SKILLS, INC.

Provider Business Mailing Address
First Line	:	PO BOX 3206
Second Line	:
City	:	PUEBLO
State	:	CO
Zip	:	81005-0206
Country	:	US
Telephone Number	:	719-543-7473
Fax Number	:

Provider Business Practice Location Address
First Line	:	3595 E FOUNTAIN BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80910-1733
Country	:	US
Telephone Number	:	719-543-7473
Fax Number	:

Authorized Official
Title or Position	:	CEO/EXEC. DIRECTOR
Name	:	MELISSA TORRES
Credential	:
Telephone Number	:	719-543-7473

Provider Enumeration Date	:	12/28/2015
Last Update Date	:	12/28/2015

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